The transplant list is at a record high, with more than 8,000 people waiting for organs
Two hospitals in Cambridge are at the heart of a trial that could see hundreds more lives saved each year. Hundreds more organs could be saved for transplant every year thanks to preservation techniques being trialled by NHS doctors at hospitals including Addenbrooke’s and Royal Papworth in Cambridge.
Several major hospitals in England are running a pilot to keep donor organs preserved for longer so checks can be carried out to see whether they are suitable for transplant. There is not always enough time to carry out tests on organs before they need to be used, meaning doctors are not always confident about accepting them for operations.
If successful, the pilot would lead to the first full national network in the world for reconditioning organs. Under the scheme, up to 750 more organ transplants could be carried out every year – a 19% rise on current figures. This could include up to 202 more liver transplants being carried out, up to 202 more lung transplants, and up to 345 additional kidney transplants.
Perfusion is a technique for circulating oxygenated blood or nutrient-rich fluids through organs, preserving their function and enabling more time for them to be assessed. The first lung pilot centre has opened at Royal Papworth Hospital in Cambridge, and will be followed by lung pilot sites at the Freeman Hospital in Newcastle and Harefield Hospital in London.
A dedicated perfusion suite at Addenbrooke’s opened last year and is the first of its kind in the UK. Some 12 liver and kidney pilot centres will also open in the coming months.
Addenbrooke’s multi-visceral transplant lead, Mr Andrew Butler, welcomed the trial, explaining that perfusion machines provide a greater opportunity accept multiple organs and match them to recipients. An example was a liver that was perfused for 32 hours before half of it was successfully used to assist a 15-year-old patient.
Mr Butler, who helped pioneer the perfusion technique, said: “Our greatest wish is to honour the gift from the donor by using it to save the life of another person. We are proud to have played a key role in the development of the perfusion machine, since it greatly improves the odds of achieving that goal and we are delighted to be selected as one of the ARC pilot sites.”
Transplant list at record high
NHS Blood and Transplant (NHSBT) says changes are needed to save more organs owing to the record high transplant waiting list, which is consistently over 8,000 people. The potential donor pool is also falling as people live longer and have long-term health conditions.
Derek Manas, medical director for organ and tissue donation and transplantation at NHSBT, told the Press Association the aim is to create “centres of excellence” that benefit patients across the country. Some trusts already have perfusion techniques but the aim is to standardise practice and create a network.
“There are two aims of perfusion,” he said. “One is to extend the preservation time – the standard currently is to put all organs in a box of ice. What the perfusion machines will do is give us more time to keep the organs viable… So you can keep organs on a machine until the theatre is available, until surgeons are available, until anaesthetic staff are available and so on.
“The length of time will depend on each organ. The heart still probably has the least extended time. At the moment, in a box of ice, you’ve got about three hours at the most, but with machine perfusion you’ve got eight hours and probably longer. For livers, you can probably extend the time to 12 to 24 hours.
“We’re not sure exactly how long we can extend the time for, but it certainly will make a significant difference to transplants. The other value of perfusion is assessing the functionality of the organs. Most organ donors now are older… so putting organs on a machine allows you to assess their function.”
He said several hospitals do perfusion “but the pilot is about trying to find where the best location should be”. He added: “It’s hugely inequitable at the moment, because some patients are getting the benefit and others are not. The pilot will hopefully change that.”
Programme could save hundreds of lives
With perfusion, organs are connected to a device by tubes going into the arteries. Organs are then fed blood or an oxygenated substance, plus nutrients. Waste products such as bile are removed. With a full reconditioning network, organs could also receive additional reconditioning treatments, such as surgical repairs, medications, blood group changing or cell therapies.
Dr Zubir Ahmed, the Government’s health innovation and safety minister, said: “Every person waiting for a transplant deserves the best possible chance of receiving one. We are committed to funding this crucial programme because, as part of our plans to build an NHS fit for the future, we want to use the latest technology to give clinicians more time and better tools to assess organs safely, honouring the extraordinary generosity of donors and their families.
“This programme could mean saving and transforming hundreds of lives that might otherwise have been lost. As a transplant surgeon, I know first-hand what that can mean for patients and families, and I am proud that the UK is leading the world in this approach.”
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